Induced psoriasis after rituximab therapy for rheumatoid arthritis: a case report and review of the literature

Rituximab is a human/murine monoclonal antibody targeting the CD20 antigen on B-lymphocytes surface. Although it has been licensed for treatment of non-Hodgkin’s lymphoma, nowadays it is also a novel therapy for autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus. Despite the increasing evidence regarding the safety and efficacy of rituximab in these conditions, many cutaneous adverse events have been reported. Here, we describe the case of a 69-year-old patient, affected by rheumatoid arthritis, who developed psoriatic lesions on her trunk and arms, three months after the second course of rituximab. Similar cases appearing in the literature will also be briefly mentioned.     

Severe neutropenia due to naproxen therapy in rheumatoid arthritis: a case report and review of literature

Rheumatoid arthritis is a chronic inflammatory disease that primarily affects the joints and is often treated with non-steroidal anti-inflammatory drugs (NSAIDs) on demand and disease-modifying antirheumatic drugs (DMARDs), with a relatively low risk of side effects. Although an infrequent side effect, neutropenia has been described as a sequel of NSAIDs. We report a case of neutropenia proven (by rechallenge) to be due to naproxen therapy. The literature on neutropenia during treatment with NSAIDs and DMARDs is briefly reviewed.     

Klinefelter's syndrome and rheumatoid arthritis report of a case and review of the literature

Summary Our case report describes a patient with Klinefelter's syndrome (KFS) associated with rheumatoid arthritis (RA). He had active RA in 1985 but his arthritis almost subsided in 1993 without intensive treatments for RA as well as KFS. Recently, the lower levels of testosterone in male RA patients, especially at the active phase has been reported. However, it is still questionable whether hypogonadism is a predisposing factor or just a consequence of disease. Since our case had a mild clinical course, and since the incidence of RA associated with KFS is very rare in comparison with other rheumatic diseases, may suggest that the low levels of testosterone are not a predisposing factor to the activity of RA.     

Association between rheumatoid arthritis and systemic mastocytosis: a case report and literature review

Clinical Rheumatology - Classically, mast cells (MC) are considered as important actors of the innate immune response playing a pivotal role in IgE-mediated allergic and antiparasite responses. In...     

Jejunal vasculitis in patient with rheumatoid arthritis: case report and literature review

Abstract

A 57-year-old man with rheumatoid arthritis presented severe abdominal pain symptomatic of panperitonitis. Computer tomography findings were consistent with vasculitis on the jejunum. Confirmatory angiography was conducted. Since abdominal vasculitis in rheumatoid arthritis is very rare, early diagnosis and treatment should be done according to clinical manifestation. In this case, high-dose steroid treatment was applied based on clinical manifestation, laboratory findings, and radiologic finding. After therapy, clinical manifestation and flare-up arthritis diminished.     

Jejunal vasculitis in patient with rheumatoid arthritis: case report and literature review

A 57-year-old man with rheumatoid arthritis presented severe abdominal pain symptomatic of panperitonitis. Computer tomography findings were consistent with vasculitis on the jejunum. Confirmatory angiography was conducted. Since abdominal vasculitis in rheumatoid arthritis is very rare, early diagnosis and treatment should be done according to clinical manifestation. In this case, high-dose steroid treatment was applied based on clinical manifestation, laboratory findings, and radiologic finding. After therapy, clinical manifestation and flare-up arthritis diminished.     

Recurrent pneumothorax associated with pulmonary nodules after leflunomide therapy in rheumatoid arthritis: a case report and review of the literature

Rheumatoid arthritis (RA) is a multisystem inflammatory disease characterized by destructive synovitis and systemic extraarticular involvement. One of the most common pulmonary manifestations of RA is rheumatoid nodule. Spontaneous pneumothorax also very rare pulmonary finding and could be associated with pulmonary nodules. Antirheumatic drugs, methotrexate, leflunomide (LEF), infliximab and etanercept, were known as risk factors for developing rheumatoid nodule. However, there was no case report of rheumatoid nodule-associated pneumothorax with the use of LEF. We report, first, herein a case of 46-year-old woman with RA who suffered recurrent spontaneous pneumothorax associated with multiple bilateral subpleural cavitary nodules during treatment with LEF. We reviewed the cases of LEF-related pulmonary nodules developed in patients with RA. Thus, we suggested that pneumothorax can be a rare respiratory fatal complication in patients with RA with pulmonary nodules and LEF can be a rare cause of these manifestations.     

Polychondritis and rheumatoid arthritis. Case report and review of the literature

Summary We present the case history of a 50-year-old man with seropositive erosive rheumatoid arthritis of 30-years standing who developed polychondritis simultaneously with several extra-articular rheumatoid manifestations, such as anaemia, subcutaneous nodules, pericarditis and episcleritis. The relevant literature is reviewed. Gradually, all symptoms and signs disappeared after start of treatment with 30 mg prednisone and 100 mg azathioprine daily. We suggest that the polychronditis in this patient was also an extra-articular manifestation of rheumatoid arthritis.     

Post-COVID-19 arthritis: a case report and literature review

Clinical Rheumatology - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is the novel pathogen responsible for the coronavirus disease 19 (COVID-19) outbreak. Researchers and clinicians...     

Biventricular thrombus and associated myocardial infarction in a rheumatoid arthritis patient: a case report and literature review

Autoimmune diseases including rheumatoid arthritis have an increased incidence of cardiovascular disease. Rheumatoid arthritis (RA) confers a prothrombotic state and is associated with venous thrombosis, but its association with arterial thrombosis and embolism is not clear. In present report, we introduce a unique case of a 42-year-old woman with RA, who was admitted to the emergency service with back pain and diagnosed as having large right and left ventricular thrombus and myocardial infarction, associated with embolization of the thrombus. We also review the literature about RA and arterial and intraventricular thrombosis.     

Gold colitis induced by auranofin treatment of rheumatoid arthritis: case report and review of the literature.

A case of ulcerative colitis occurred during treatment of rheumatoid arthritis with the new oral gold preparation auranofin after a cumulative dose of 2160 mg. A barium enema showed loss of mucosal pattern and a rectal biopsy disclosed deep erosions, mucosal inflammation, and crypt abscesses. Precipitates of gold were seen in the periglandular stroma. On electron microscopy the gold deposits seemed to be identical to granules described in gold nephropathy. As the extrapolated serum gold level was within the normal range at the onset of the complication, the morphological findings suggested a local toxicity of the drug. The patient recovered within 14 days of withdrawal of auranofin and the start of therapy with sulphasalazine and steroids. A review of the published work shows that the previously reported mortality in gold colitis of 40% has decreased in recent years. The causes of this decrease may be both the earlier diagnosis of gold colitis and the improved intensive care of its severe complications.     

Klinefelter’s syndrome and rheumatoid arthritis: report of a case and review of the literature

Kilnefelter’s syndrome (KFS) tends to be associated with autoimmune diseases. Although several reports describe association of KFS with different autoimmune diseases, association with rheumatoid arthritis is very rare. We report a case of (KFS) who had seropositive erosive rheumatoid arthritis, and discuss the role of sex hormones/X chromosome in the pathogenesis of disease.     

New-onset multiple sclerosis associated with adalimumab treatment in rheumatoid arthritis: a case report and literature review

Tumor necrosis factor (TNF) antagonists have brought about a significant advancement in treatment for autoimmune diseases such as rheumatoid arthritis (RA) and Crohn’s disease; however, they are accompanied with a risk of severe adverse effects. We report the case of a 68-year-old female with a 33-year history of RA that developed multiple sclerosis (MS) during adalimumab (ADM) treatment at 22 months after the initial administration. Her first neurological symptom was mild dizziness, which progressed to severe dizziness with gait disturbance within 2 weeks. Fortunately, when she had this neurological disorder, ADM treatment was being transiently stopped because she was in the perioperative period. Repeated magnetic resonance imaging examinations revealed multiple demyelinating lesions in her brain, leading to the diagnosis of MS. The patient completely recovered spontaneously from the symptoms in several days. A review of the literature revealed another 15 cases of MS associated with anti-TNF-α treatment, emphasizing the importance of detecting neurological symptoms and discontinuing the anti-TNF-α therapy.     

Insufficiency-type stress fractures in rheumatoid arthritis: report of an interesting case and review of the literature

A case of multiple insufficiency-type stress fractures (32 fractures), in the absence of any trauma, in a 51-year-old white woman with rheumatoid arthritis is described. The fractures healed satisfactorily with rest, treatment of osteoporosis, and discontinuation of her steroid therapy, following which a proximal humeral and total knee arthroplasties were successfully performed. The factors contributory to the development of stress fractures in rheumatoid arthritis are discussed, the literature is reviewed, and the salient features of our case are highlighted.     

Etanercept-induced anti-Jo-1-antibody-positive polymyositis in a patient with rheumatoid arthritis: a case report and review of the literature

Antitumor necrosis factor (TNF) therapy has been associated with adverse immunologic events including systemic lupus erythematosus. However, the development of polymyositis (PM)/dermatomyositis (DM) associated with anti-TNF therapy is extremely rare. We experienced a case of a 48-year-old female with rheumatoid arthritis (RA) who had anti-Jo-1 antibodies and interstitial lung disease but no previous history of PM/DM and who developed PM soon after the initiation of etanercept (ETN) therapy for RA. The patient recovered upon withdrawal from ETN and corticosteroid (CS) therapies. Only four reports of PM/DM associated with anti-TNF therapy for RA could be found in the literature. The patients described in three of the four reports were positive for anti-Jo-1 antibodies before the initiation of anti-TNF therapy, and in all the cases, recovery occurred after the cessation of anti-TNF-agent administration and CS therapy. These results suggest a relationship between the onset of PM/DM with anti-Jo-1 antibody and anti-TNF therapy for RA.